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Dect~r~~ion af Damicite and Citizen5hip
't'O Tl ll: S'fA7~1~ AN1) COUNTY 7'AX ASSI:SSUR,
_ ST. LUCIE ~-OUNTY, I~LOItIUA: ~~Q
11?is is my dcrlaration of Uomicilc and Citizcnship in lhc Statc of Florida thal 1 am filin~ ihis day in
accorclancc, ancl in conformity ~yith Scction 2?2.17, Floricfa Statutcs.
' erse
1 was fonncrly a Irga) residcnt of ___~s~~~ ~''1 ,_,V~.°~ ~ and 1
(ci~r) (stste)
residrd at _~.s~ ~~~~S , Howcver, 1 havc chanbed my domiciic to
(Strecl anJ Number)
and am and have been a boiia fide residcnt of the State of rlorida since day ot'
_`~~L• 19_~, and 1 residc at a ~ ~~ct v~ C~~
treet and Number)
_ __~o ~c' ~____~j~ rCE~ , St . Lucie Cotmty, Fiorida,
(c~cr)
and this statement is to be taken as my cteclaration of citizenship, actual legai residence and domicile in the State
of Flarida.
(Inscr: herc any pertincnt facls, wch as sale of property or bucinrss, or relinyuishment ot cmployment at fotmtr
domicile, temo~~l of family to nc~~~ dumicilr, purchase of homr, etcJ
EAJTCRI~'G CNII_DREtd IP1 SCHOOL: HOriESTEAD EYEMPTIO':'+: ~
If enterir.g children in school, ~ - ~ .
please list their names:
' FILEO ANU RECORDEO
fT. IUCIE COUNIY ilA.
- AOCEtt PO1IRAS
CIERR CtRCUIT CQUftT t+
~I \
RECORO YERRFIEO ~.....•i~1
Fu t1 1 io PM'75
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~ I FURTlII:R CERT!f
Y that 1 will m~ister at my local address whcn the rcg~stration books rcopen, and
comply ~~~ith al! other rrq!~irements of a legal resident o~ this State.
~ 1 I=UR1'Iil;R CI:ItT1T=Y that I have no intcntion to return to my former domicile, and 1 intend to rcmain in
~ ~'br~- e rc.~ ST. LUCIE County,
~ I=lorida, pcrrnanently. ~c~'y~ - - - - ~
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~ ~ ~ v .i~~~~ :i . . S IGI~ATUR~
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~Aru ~.~.;,arid stt~it~%Yicforc mr this -_/__~day of
~ .~~nj.' / ` ' A.D. 9--~_7S
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~ ' ' • • -~r~• . ~T"in'~~i . s s
~ , C1.~RK CT RCUIT COURT rlorida
~ ~ ~ , ~ _s
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~ I3y ,r.~ ~~5 ty Clerk
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~ (To Ix ~aecu in duplic•rIr and ori~c~nrl (iled wilh Clerk Circuil Cou•1, anJ AuplNate w•ith Ta~ Aascsu?t)
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